Typology of Psychiatric Emergency Services in the United Kingdom: A narrative literature Review

Abstract Background Mental health crisis requiring emergency access to psychiatric service can occur at any time. Psychiatric Emergency Service (PES) is described as one that provides an immediate response to an individual in crisis within the first 24 hours. Presently, several PESs are available in the United Kingdom (UK) with the aim of providing prompt and effective assessment, management and in some cases treatment and/or referral. Therefore, this study aims to provide a detailed narrative literature review of Psychiatric Emergency Service (PES) currently available in the UK Method Electronic search of five key databases (MEDLINE, PsychINFO, EMBASE, AMED and PUBMED) was conducted. Studies were included if it described a service that provides immediate response in mental health crisis within the first 24 hours. Excluded studies did not describe a PES, non-English, and were not conducted in UK. Results Nine PESs were found. Amongst the 9 services, more papers described crisis resolution home treatment. Majority of the papers reported services within England than other countries within the UK. Conclusion All forms of PES are beneficial, particularly to mental health service users, but not without some shortcomings. There is a need to continue carrying out methodological research that evaluate impact, cost-effectiveness as well as identify methods of optimising the beneficial outcomes of all models of PES. This may help inform researchers, policy makers and commissioners, service users and carers, service providers and many more on how to ensure current and future PES meet the needs as well as aid recovery during crisis.

Download Full-text

Typology of psychiatric emergency services in the United Kingdom: a narrative literature review

BMC Psychiatry ◽

10.1186/s12888-020-02983-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Opeyemi Odejimi ◽

Dhruba Bagchi ◽

George Tadros

Keyword(s):

Mental Health ◽

Emergency Service ◽

Psychiatric Emergency ◽

Service Users ◽

Mental Health Crisis ◽

Health Crisis ◽

The United Kingdom ◽

Narrative Literature ◽

Narrative Literature Review ◽

The Uk

Abstract Background Mental health crisis requiring emergency access to psychiatric service can occur at any time. Psychiatric Emergency Service (PES) is described as one that provides an immediate response to an individual in crisis within the first 24 h. Presently, several types of PESs are available in the United Kingdom (UK) with the aim of providing prompt and effective assessment and management of patients. Therefore, this study aims to provide a detailed narrative literature review of the various types of Psychiatric Emergency Service (PES) currently available in the UK. Method Electronic search of five key databases (MEDLINE, PsychINFO, EMBASE, AMED and PUBMED) was conducted. Studies were included if it described a mental health service in the UK that provides immediate response in mental health crisis within the first 24 h. Excluded studies did not describe a PES, non-English, and were not conducted in UK. Results Nine types of PESs were found. Amongst the 9 services, more papers described crisis resolution home treatment. Majority of the papers reported services within England than other countries within the UK. Conclusion All types of PESs were described as beneficial, particularly to mental health service users, but not without some shortcomings. There is a need to continue carrying out methodological research that evaluate impact, cost-effectiveness as well as identify methods of optimising the beneficial outcomes of the various types of PESs. This may help inform researchers, policy makers and commissioners, service users and carers, service providers and many more on how to ensure current and future PESs meet the needs as well as aid recovery during crisis.

Download Full-text

Typology of Psychiatric Emergency Services in the United Kingdom: A narrative literature Review

10.21203/rs.3.rs-28874/v2 ◽

2020 ◽

Author(s):

Opeyemi Odejimi ◽

Dhruba Bagchi ◽

George Tadros

Keyword(s):

Mental Health ◽

Emergency Service ◽

Psychiatric Emergency ◽

Service Users ◽

Mental Health Crisis ◽

Health Crisis ◽

The United Kingdom ◽

Narrative Literature ◽

Narrative Literature Review ◽

The Uk

Abstract Background: Mental health crisis requiring emergency access to psychiatric service can occur at any time. Psychiatric Emergency Service (PES) is described as one that provides an immediate response to an individual in crisis within the first 24 hours. Presently, several types of PESs are available in the United Kingdom (UK) with the aim of providing prompt and effective assessment and management of patients. Therefore, this study aims to provide a detailed narrative literature review of the various types of Psychiatric Emergency Service (PES) currently available in the UKMethod: Electronic search of five key databases (MEDLINE, PsychINFO, EMBASE, AMED and PUBMED) was conducted. Studies were included if it described a mental health service in the UK that provides immediate response in mental health crisis within the first 24 hours. Excluded studies did not describe a PES, non-English, and were not conducted in UK. Results: Nine types of PESs were found. Amongst the 9 services, more papers described crisis resolution home treatment. Majority of the papers reported services within England than other countries within the UK. Conclusion: All types of PESs were described as beneficial, particularly to mental health service users, but not without some shortcomings. There is a need to continue carrying out methodological research that evaluate impact, cost-effectiveness as well as identify methods of optimising the beneficial outcomes of the various types of PESs. This may help inform researchers, policy makers and commissioners, service users and carers, service providers and many more on how to ensure current and future PESs meet the needs as well as aid recovery during crisis.

Download Full-text

Typology of Psychiatric Emergency Services in the United Kingdom: A narrative literature Review

10.21203/rs.3.rs-28874/v3 ◽

2020 ◽

Author(s):

Opeyemi Odejimi ◽

Dhruba Bagchi ◽

George Tadros

Keyword(s):

Mental Health ◽

Emergency Service ◽

Psychiatric Emergency ◽

Service Users ◽

Mental Health Crisis ◽

Health Crisis ◽

The United Kingdom ◽

Narrative Literature ◽

Narrative Literature Review ◽

The Uk

Download Full-text

A narrative literature review of the typology of psychiatric emergency services in the UK

BJPsych Open ◽

10.1192/bjo.2021.629 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S235-S235

Author(s):

Dhruba Bagchi ◽

George Tadros ◽

Opeyemi Odejimi

Keyword(s):

Mental Health ◽

Mental Health Service ◽

Health Service ◽

Emergency Service ◽

Emergency Services ◽

Psychiatric Emergency ◽

Service Users ◽

Psychiatric Emergency Services ◽

Crisis Resolution ◽

The Uk

AimsThis study aims to provide a detailed literature review of the different forms of Psychiatric Emergency Services currently available within the UK.Background1 in 6 individuals have one form of mental health disorders. Mental health crisis resulting in an individual requiring access to Psychiatric Emergency Service (PES) can occur at any time. Psychiatric Emergency Service (PES) is described as one that provides an immediate response to an individual in crisis within the first 24 hours. Presently, several PESs are available in the UK with the aim of providing prompt and effective assessment, management and in some cases treatment and/or referral. Over the years, economic and political influences have greatly determined the service delivery models of PES. Indeed, these services vary in name, accessibility, structure, professionals involved, outcomes and many more.MethodElectronic search of five key databases (MEDLINE, PsychINFO, EMBASE, AMED and PUBMED) was carried out to identify various models of PES in the UK. Various combinations of search terms were used and studies which met the inclusion criteria were selected. Studies were included if they were written in English, conducted within the United Kingdom, and described a form of PES. Search was not limited by years and this is to help have a comprehensive overview as well as show changes over time of the various models of psychiatric emergency services. Studies which did not meet any of the criteria detailed above were excluded.ResultIn total, 59 relevant studies were found which identified nine type of PES-Crisis resolution home treatment, police officer intervention, street triage, mental health liaison services in the Emergency Department, psychiatric assessment unit, integrated services, voluntary services and crisis house. There were more papers describing Crisis resolution home treatment services than the others. Furthermore, majority of the papers reported services within England than other countries within the UK.ConclusionAll forms of PES are beneficial, particularly to mental health service users, but not without some shortcomings. There is a need to continue carrying out methodological research that evaluate impact, cost-effectiveness as well as identify methods of optimising the beneficial outcomes of all models of PES. This will inform researchers, educationist, policy makers and commissioners, service users and carers, service providers and many more on how to ensure current and future PES meet the needs as well as aid recovery of mental health service users.

Download Full-text

What are the experiences and the perceptions of service users attending Emergency Department for a mental health crisis? A systematic review

International Journal of Mental Health Nursing ◽

10.1111/inm.12968 ◽

2021 ◽

Author(s):

Maya Sacre ◽

Rikke Albert ◽

Juanita Hoe

Keyword(s):

Mental Health ◽

Systematic Review ◽

Emergency Department ◽

Service Users ◽

Mental Health Crisis ◽

Health Crisis

Download Full-text

The Need for Making Contact in Times of Crisis

Archives of Psychology ◽

10.31296/aop.v3i3.99 ◽

2019 ◽

Vol 3 (3) ◽

Author(s):

Barbara Groot ◽

Marian Vink ◽

Gert Schout ◽

Tineke Abma

Keyword(s):

Psychiatric Inpatient ◽

Psychiatric Emergency ◽

Service Users ◽

Mental Health Crisis ◽

Patient Journey ◽

Health Crisis ◽

Responsive Evaluation ◽

Body Of Knowledge ◽

Psychiatric Inpatient Unit ◽

The Moment

Descriptive studies on the experiences of service users in psychiatric emergency wards are increasing. However, the experience of users throughout the whole psychiatric emergency procedure, the ‘patient journey’ from the moment of mental health crisis leading to admission in a psychiatric inpatient unit, has rarely been studied. This article aims to make a further contribution to this body of knowledge by not only describing the service-users’ journey but also shows whether and how that perspective is received by other stakeholders like healthcare professionals, family-members, police, representatives of the municipality and ambulance staff and representatives of the municipality, to jointly make action-plans for improvement. A responsive evaluation including interviews, focus groups and dialogue session with a transformative aim was conducted in a mixed team of researchers with and without experiential knowledge. Service users and other stakeholders agree on the main issues: the importance of contact; signaling; expropriation and earning freedom. However, proposed actions differed between users and professionals. Service users proposed relational actions to offer good care. Professionals recommended actions in response to issues of fragmentation and discontinuity. We conclude that responsive evaluation can help to create a more informed and kaleidoscopic view of the complexity of psychiatric emergency care. Therefore, we recommend that various actions need to be considered to meet the needs of service users better covering all phases of Tronto’s care ethical model: caring about, taking care, caring giving and care receiving.

Download Full-text

Acute Day Units for mental health crises: A qualitative study of service user and staff views and experiences

10.1101/2020.11.20.20235374 ◽

2020 ◽

Author(s):

Nicola Morant ◽

Michael Davidson ◽

Jane Wackett ◽

Danielle Lamb ◽

Vanessa Pinfold ◽

...

Keyword(s):

Mental Health ◽

Qualitative Study ◽

Acute Care ◽

User Satisfaction ◽

Service Users ◽

Mental Health Crisis ◽

Structured Interviews ◽

Short Term Treatment ◽

Health Crisis ◽

Care Systems

AbstractBackgroundAcute Day Units (ADUs) provide intensive, non-residential, short-term treatment for adults in mental health crisis. They currently exist in approximately 30% of health localities in England, but there is little research into their functioning or effectiveness, and how this form of crisis care is experienced by service users. This qualitative study explores the views and experiences of stakeholders who use and work in ADUs.MethodsWe conducted 36 semi-structured interviews with service users, staff and carers at four ADUs in England. Data were analysed using thematic analysis.ResultsBoth service users and staff provided generally positive accounts of using or working in ADUs. Valued features were structured programmes that provide routine, meaningful group activities, and opportunities for peer contact and emotional, practical and peer support, within a ‘safe’ environment. Aspects of ADU care were often described as enabling personal and social connections that contribute to shifting from crisis to recovery. ADUs were compared favourably to other forms of home- and hospital-based acute care, particularly in providing more therapeutic input and social contact. Some service users and staff thought ADU lengths of stay should be extended slightly, and staff described some ADUs being under-utilised or poorly-understood by referrers in local acute care systems.ConclusionsMulti-site qualitative data suggests that ADUs provide a distinctive and valued contribution to acute care systems, and can avoid known problems associated with other forms of acute care, such as low user satisfaction, stressful ward environments, and little therapeutic input or positive peer contact. Findings suggest there may be grounds for recommending further development and more widespread implementation of ADUs to increase choice within local acute care systems.

Download Full-text

Acute day units in non-residential settings for people in mental health crisis: the AD-CARE mixed-methods study

Health Services and Delivery Research ◽

10.3310/hsdr09180 ◽

2021 ◽

Vol 9 (18) ◽

pp. 1-122

Author(s):

David Osborn ◽

Danielle Lamb ◽

Alastair Canaway ◽

Michael Davidson ◽

Graziella Favarato ◽

...

Keyword(s):

Mental Health ◽

Health Services ◽

Well Being ◽

Service Users ◽

Mental Health Crisis ◽

Work Package ◽

Crisis Resolution ◽

Data Set ◽

Health Crisis ◽

Crisis Resolution Teams

Background For people in mental health crisis, acute day units provide daily structured sessions and peer support in non-residential settings as an alternative to crisis resolution teams. Objectives To investigate the provision, effectiveness, intervention acceptability and re-admission rates of acute day units. Design Work package 1 – mapping and national questionnaire survey of acute day units. Work package 2.1 – cohort study comparing outcomes during a 6-month period between acute day unit and crisis resolution team participants. Work package 2.2 – qualitative interviews with staff and service users of acute day units. Work package 3 – a cohort study within the Mental Health Minimum Data Set exploring re-admissions to acute care over 6 months. A patient and public involvement group supported the study throughout. Setting and participants Work package 1 – all non-residential acute day units (NHS and voluntary sector) in England. Work packages 2.1 and 2.2 – four NHS trusts with staff, service users and carers in acute day units and crisis resolution teams. Work package 3 – all individuals using mental health NHS trusts in England. Results Work package 1 – we identified 27 acute day units in 17 out of 58 trusts. Acute day units are typically available on weekdays from 10 a.m. to 4 p.m., providing a wide range of interventions and a multidisciplinary team, including clinicians, and having an average attendance of 5 weeks. Work package 2.1 – we recruited 744 participants (acute day units, n = 431; crisis resolution teams, n = 312). In the primary analysis, 21% of acute day unit participants (vs. 23% of crisis resolution team participants) were re-admitted to acute mental health services over 6 months. There was no statistically significant difference in the fully adjusted model (acute day unit hazard ratio 0.78, 95% confidence interval 0.54 to 1.14; p = 0.20), with highly heterogeneous results between trusts. Acute day unit participants had higher satisfaction and well-being scores and lower depression scores than crisis resolution team participants. The health economics analysis found no difference in resource use or cost between the acute day unit and crisis resolution team groups in the fully adjusted analysis. Work package 2.2 – 36 people were interviewed (acute day unit staff, n = 12; service users, n = 21; carers, n = 3). There was an overwhelming consensus that acute day units are highly valued. Service users found the high amount of contact time and staff continuity, peer support and structure provided by acute day units particularly beneficial. Staff also valued providing continuity, building strong therapeutic relationships and providing a variety of flexible, personalised support. Work package 3 – of 231,998 individuals discharged from acute care (crisis resolution team, acute day unit or inpatient ward), 21.4% were re-admitted for acute treatment within 6 months, with women, single people, people of mixed or black ethnicity, those living in more deprived areas and those in the severe psychosis care cluster being more likely to be re-admitted. Little variation in re-admissions was explained at the trust level, or between trusts with and trusts without acute day units (adjusted odds ratio 0.96, 95% confidence interval 0.80 to 1.15). Limitations In work package 1, some of the information is likely to be incomplete as a result of trusts’ self-reporting. There may have been recruitment bias in work packages 2.1 and 2.2. Part of the health economics analysis relied on clinical Health of the Nations Outcome Scale ratings. The Mental Health Minimum Data Set did not contain a variable identifying acute day units, and some covariates had a considerable number of missing data. Conclusions Acute day units are not provided routinely in the NHS but are highly valued by staff and service users, giving better outcomes in terms of satisfaction, well-being and depression than, and no significant differences in risk of re-admission or increased costs from, crisis resolution teams. Future work should investigate wider health and care system structures and the place of acute day units within them; the development of a model of best practice for acute day units; and staff turnover and well-being (including the impacts of these on care). Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 18. See the NIHR Journals Library website for further project information.

Download Full-text

Care-pathways for patients presenting to emergency ambulance services with self-harm: national survey

Emergency Medicine Journal ◽

10.1136/emermed-2019-208967 ◽

2020 ◽

pp. emermed-2019-208967

Author(s):

Mohammed Gaber Zayed ◽

Victoria Williams ◽

Alexander Charles Glendenning ◽

Jenna Katherine Bulger ◽

Tom Hewes ◽

...

Keyword(s):

Mental Health ◽

Hospital Admissions ◽

Psychosocial Assessment ◽

Mental Health Crisis ◽

Health Crisis ◽

Alternative Pathways ◽

Mental Health Patients ◽

Emergency Ambulance ◽

Self Harm ◽

The Uk

BackgroundSelf-harm is among the top five causes of acute hospital admissions and ambulance clinicians are often the first point of contact. However, the Emergency Department (ED) may not be the most appropriate place of care and little is known about the existence or nature of alternative pathways available to UK ambulance services. This survey describes the current management pathways used by ambulance services for patients who have self-harmed.MethodsA structured questionnaire was sent to all UK ambulance services by email and followed up by telephone in 2018. Three independent researchers (two clinical) coded responses which were analysed thematically.ResultsAll 13 UK ambulance services responded to the survey: nine by email and four by telephone interview. Two services reported a service-wide protocol for managing people presenting with self-harm, with referral to mental health crisis team available as an alternative to conveyance to ED, following on-scene psychosocial assessment. Four services reported local pathways for managing mental health patients which included care of patients who had self-harmed. Four services reported being in the process of developing pathways for managing mental health patients. Six services reported no service-wide nor local pathways for managing self-harm patients. No robust evaluation of new care models was reported.ConclusionPractice in ambulance services in the UK is variable, with a minority having a specific clinical pathway for managing self-harm, with an option to avoid ED. New pathways for patients who have self-harmed must be evaluated in terms of safety, clinical and cost-effectiveness.

Download Full-text